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Home My WebLink About6742-z FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTleOLD, hL Y. I~IIL~ING FEIMIT (THIS PEP, MIT MUST BE KEPT ON THE PI~EMISES~UNTIL FULL C~tON OF THE WORK AUTHORIZED) N? 67,42 Z Permission i~ hereby graneid to: £e.t,e~...~e ~:er...&._~e~ .i~.ta~ .............. ....... .~.....~.~. r~...o~.L~.~ .................................... ~t. ~'enes ~.~'. 11~0 at premises located at ..~.~...~.~.CI~..~J,~ ................................................................................... ........................................... ~.~.~,t~9~,~, ......... ~.~., ............................................................................... pursuant to application dated ...................... ~. ....... .1.~ ............ , 19~.~..., and approved by the Building Inspector. ~ k S~FFOLK COUNTY DEPARTMENT OF HEALTH H!.D. Reference No. - APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SiEWAGE DISPOSAL SYSTEM Address ~ ~%~.,~%~,~mnm~ ~_~'~ ~,tm,~. ~,%~,!6. Section 2. Property i?,6ation $~ ~/~,n ~)~ ~ ~.~ ' ~ 7. Lot No. [~t ~/o ~-~ '~ ~8, Private well Village ~O~4o~) Township ~o~O~O ~9. Public water 3. Public Water Company name ~ ~Distance to main 4. Lot size: Width /O~ feet Length ~oofeet (Enter on center plot below) 10. Sewage Dispos~stem: Precast ~Equivalent Block A. ~p0 ~allon septic tank: 5Preca~lock Special B. ~ ~hing pools: Number If private well fill in blanks below: Tank capacity ~als. Pump ¢.P.~. Total well depth gh 'Amount of water well Test Hole Data Peet 0 4 6 8 10 12 14 16 18 "Construction o~ authorized installations will The undersigned CERTIFIES: be in accordance with the Suffolk County Department: of Health's current stand- aKds thereto." ---~ 0wndr or'Builder FOR HEALTH DEPARTMENT UME ONLY. Eased on the infdrmation'presented herewith, it is the opinion of the Health Department, that an:.adequate and satisfactory Sewage Disposal System can be installed on this plot. S-15 Revised ~/]/72 Examined Approved FOENI NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ..... Permit No ....................... Disapproved a/c ........................................... .... (Building Inspector') APPLICATION FOP, BUILDING PERMIT Date ?--18 19...~2 .... INSTRUCTIONS a. This application must be completely filled in by typewriter or' in i~k and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according ~o schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn 9n the diagram which is part of this application. c. The work covered by this application may not be commenced befo~b issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~or removal or demolition, as herein described. The applicant agrees to comply with ail applicable bws, ordnances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ~$ H~l~hWoj~d~ Ct., St. James. New York (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner and builder Name of owner of premises .....~.,e.,~;~..~.....~...O..~...~.9.~.~..~....~..~.....R,.O.~,~.H..?.,.~ ................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Mep No.: D~(~CIBED Lot No. Street and Number . ~O~J:hold Municipality State existing use and occupancy of premises and intended use andi occupancy of proposed construction: a. Exisiting use and occupancy V~lr~'a~ YA~'AN~ L~ND ONE FAMILY DWELLIN~ b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .... X' ........... Addition .................. Alteration ............ ~ ... Repair .................. Removal .................. Demolition .................... Other Work ................................................. i .... (Description) 4. Estimated Cost ....... ~I~.,.~)~).Q~.~.~I ............................. Fee ....~.~:,/..-..~.~. ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... :t ................... Number of dwelling units on each floor ......................... If garage, number of cars ............ .~ ........................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ....... ~ ............... Rear .............. ~ ............. Depth .......l ........ Height ......]~& ............. Number of Stories ........... 'l ............................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ........................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... ~ ..................... Rear ............. b~ .......... Depth ........... ~,.~ ...... Height ........ ;~.,~ ....... Number of Stories ...........~ ....................................................................................................... 9. Size of Pot: Front ...............~,0~ ................................. Rear .............. ~CI0 ..................... Depth ............. ~0 ........... 10. Date of Purchase ........ /~.:~.~'.~ ................................. Name of Former Owner ...... ~uOR~'~1.r~]~) ......................... 1 1. Zone or use district in which premises are situated .... ..~.~.~.~.~-~t.~.. .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ,~. ....................................... 13. Will lot be regraded ........¥~ ............. Will excess fill be removed from premises: (]() Yes ( ) Nc 14. Name of Owner of premises ...~O~l~..~.*...FZl,~e ................. Address ~['~.~)[~.?.~.~hone No..~.~ .'.~.~..~../~.. Name of Architect .;[~OQJ~lg...r~,~...R~11g, eO ........................... Address~,~C,,~[JtJ~J.~e..~,,Zo Phone, No..~l~...,.~,~_. Name of Contractor ~Z~..~,~..O~e~. ............................. Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensi ,ns from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, IS S COUNTY OF '"'~]PO'7.~ ........... ~ ' ............................................ .~l~'~..l~,~..~.~.,N[~. .................... being duly sworn, deposes and says that he is the ~licom (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etc/;~ of said owner or owners, and is duly authorized to perform or have perforr~dj the said work ~nd to make and file this application; that all statements contained in this application are true ~6 t~e best of his kncJwledge and belief and tha~ the work will be performed in the manner set forth in the application fj~d/herewith. Sworn to before me this / ,¢ //, / r~/ .......... ./.~/. ......... day of ../~, .......... .~..~, .......~..., 19.~.. / '~__~( // /, Nolar Pub c (//~ //' ~ "////~ ' ¢ ~ - /~/ ~ y ,. ............ ~~....'~...,y~,oun~y ................................. .,~¢r...'~..: ...... / ............................................... (~nature of applicant) CORNELIA W. F^LVO fiOTARY pUfiLIC, State of New Yorl~ jNo, 52~4501404, Sulfolk County~,,~ ~m [.xpires March 30, lA 6'P'/ ! ?.tt.i ~ i / NOTIFY BUILDING DEPARTMENT b ~ 765-2660 9AM TO 4PM FOR REQL. It~.- ED INSPECTIONS: 1. BEFORE BACKFILLING FCUNDA- TION OR START FRAMING 2. BEFORE COVERING PIPELINE 3. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CON- STRUCTION ERRORS r ; I /-~O /g T I APPI~pVJ~D AS' NO'[ED NOTIFY ~UI~DING DEPARTMENT 1, ~EFQRE BACEFILLING FOUNDa- TION OE STAE~. F~ING 2, ~FORE COVERING F~PELINE " LOUIS T. RONiEO _J I t . I I ,I t i I L J ¸1, ./ \ I \ 1~ '-o" 4z %, q ., > V/, I. ,,~. /] / E . CONSULTING E NG I N E E'f'~ ,J ~ .o~ y Wooo .... - ~x S~ / ~0~7' c9'o.c, / "~ Z. x ~ x I COAIC ,,-~,r'~ .Z Fl4,/